Vitrectomy surgery of diabetic retinopathy complications.

UNLABELLED: Abstract

PURPOSE: To assess the anatomical and functional results after vitreoretinal surgery, in a large number of patients with complications due to diabetic retinopathy. Also, to compare the 23G vs. the 20G surgical procedures in these cases, regarding efficacy, facility, safety, and postoperative recovery.

METHODS: Interventional, retrospective, comparative study of cases operated for different complications of diabetic retinopathy between January 2000 and December 2014. All cases were operated under a local anesthesia by the same surgeon, by using standard 20G Vitrectomy (between January 2000 and October 2011) and ambulatory 23G vitrectomy (since November 2011). Cases had a complete ophthalmic evaluation and were followed-up for at least 12 months.

RESULTS: 1.267 eyes of 1.129 patients were operated between January 2000 and December 2014. 23G vitrectomy was performed in 578 eyes. The mean age in the study group was of 57.49 ± 14.17 years (ranging from 16 to 78 years old), with a male/female ratio of 0.916. The surgery indications were represented by media opacities (609 cases - 48.06%), vitreoretinal tractions and detachments (583 cases - 46.01%), persistent macular edema (38 cases - 3%) and persistent neovascularization with rubeosis (37 cases - 2.93%). A final anatomical success was obtained in 1174 cases (92.65%). Preoperative best corrected visual acuity (BCVA) (less or equal to counting fingers in 936 eyes - 73.87%), improved postoperatively in 923 eyes (72.84%), stabilized in 201 eyes (15.86%), and decreased in 143 eyes (11.28%). At a final examination, 932 eyes (73.55%) had a BCVA equal or better to 0.1. Cases operated with the 23G vitrectomy had a shorter surgery and a quicker postoperative recovery. Overall, simpler cases like vitreous hemorrhage and epimacular membranes had a better anatomical and functional result as compared to long standing or macular involvement detachments. The main intra and postoperative complications, lower with the 23G vitrectomy, were represented by iatrogenic retinal breaks, recurrent hemorrhages, redetachment, and neovascular glaucoma.

CONCLUSIONS: These results confirmed the efficacy and safety of vitreoretinal surgery in improving most complications of diabetic retinopathy on a large series. With modern, less invasive techniques, the chance of a better surgery and also a quicker patient recovery increased significantly.